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Overview
This prostate biopsy procedure is performed when a lesion is seen on ultrasound or an irregularity in the prostate is palpated with the examining finger. An anesthetic jelly is inserted into the rectum prior to the procedure. An antibiotic injection or oral antibiotics are given prior to the procedure to prevent infections. All instruments are sterile, so this is used as a precaution. The ultrasound probe is inserted into the rectum and 10-12 needle biopsies are obtained under ultrasound guidance. The needles pass through the rectal wall and into the prostate in a split second to obtain these small samples of tissue. Very little to mild discomfort is associated with this procedure. It is well tolerated and most men just have a dull ache for 24-48 hours after the procedure. Oral antibiotics are continued for three days. It is recommended that no sexual intercourse or masturbation occur for 72 hours to allow some healing of the fresh needle tracts. It is common to have blood in the urine and stool for one week, which over time will decease. Some patients will notice blood in their semen (bright red to dark brown with time) for many months after the procedure. Its takes quite some time to flush the prostate of this blood. The blood will not cause any harm to your sexual partner. We ask that you stop using any aspirin or blood thinners 7 days before the procedure.

General
The prostate biopsy is a procedure that is performed because an elevated PSA or abnormal area has been identified in your prostate gland. It is impossible to determine the nature of such irregularities without obtaining a small amount of tissue with a needle biopsy for examination under a microscope. Our goal is to determine whether these abnormalities are the signs of an early or late stage prostate cancer. You will receive at the minimum 10 biopsies and possibly more during this procedure. It may need to be repeated in 3-months if negative since there is a 20-40% reported second positive biopsy rate if the first is negative for cancer.

****Stop all Aspirin, Motrin or blood-thinning medications 10-days prior to the biopsy. (see our list of drugs at the link above)
****If you are taking a drug called Coumadin (warfarin), stop taking the medication 5 days before the biopsy.
****If you have any type of foreign implant in your body from previous surgeries please let you physician/nurse know about this, you will need additional antibiotics the day of the procedure that will require an injection.
****Please make sure that you have an escort with you to drive you home from your biopsy appointment. Even though most patients tolerate the procedure well, you will have some discomfort that may preclude you driving home by yourself.

Day before Prostate Biopsy
You will be given a prescription for an antibiotic that should be the day before and the morning of your biopsy. Enough antibiotics have been given for you to continue taking them for two more days after the biopsy. You will also have to purchase two (2) fleets enemas at your local pharmacy. Follow the instructions in the box and take one the evening before and one two hours before your biopsy. You should also not eat any solid foods after dinner the night before your biopsy. You may drink any type of liquid that you choose right up to the point of your biopsy. It helps to have some fluid in the bladder during the biopsy.

Day of the Prostate Biopsy
On the day of your appointment, report to the office where your biopsy is going to take place 15 minutes before your appointment. You will have to provide enough urine so that we may do a dipstick urine analysis to rule out any type of possible infection. Do not empty your entire bladder contents since we need some in your bladder during the biopsy. You will be asked to remove all your clothing from the waist down except your shoes and socks. You will be placed on your left side with your knees brought up to your chest. A transrectal ultrasound probe will be placed in the rectum and the prostate will be imaged and sized. This sensation is bothersome but is usually well tolerated by patients. The urologist will then obtain the multiple tiny prostate samples (10 or more). The biopsy device makes a loud noise and can startle patients; we will let you hear this before beginning. The urologist will let you know when he places the needle in the prostate and again when he plans to fire the device. The tissue will be sent to a pathology lab for evaluation which takes 5-10 working days.

After the Prostate Biopsy
After your biopsy, you will have to drink many fluids so that you may provide us with two separate urine samples from two separate voids. The most common complication is blood in the urine after the biopsy. We would like to make sure that your urine is in the process of clearing before we send you home for the day. It is normal to see blood in the urine and bowel movements for 1-2 weeks after the procedure. It should progressively diminish over that time-period. If you find that, you cannot urinate or if you are passing a large number of blood clots, then report to the office or nearest emergency room for evaluation. A physician may have to insert a catheter into the bladder for a few days to allow you urine to be drained. You should continue to drink more than your usual intake of fluids to keep your urine diluted and to prevent formation of blood clots within the bladder.

You may also experience a dull ache in the perineum for many days after the biopsy. It is recommended that you halt sexual intercourse for 3-5 days after the biopsy to allow some initial healing. Do not be surprised if you see blood in your semen (bight red to dark brown discoloration) after ejaculation. This is normal and does not cause an infectious concern for your sexual partner. This may take months to resolve. In addition, you cannot pass along cancer to your partner via your semen either.

If you have fever or chills, please take your temperature with an oral thermometer and call your physician if it reads above 100.8 F.

Follow-up
Your results will usually take 5-10 working days. If you have not heard from your physician after 14 days please call the office to find out why you have not yet received your results.